Questionable business decisions and poorly executed
strategies lead many hospitals to flush more than money down the drain. They’re
also pouring fluid medical waste into the sewers, too.

While that practice itself isn’t inherently illegal because
wastewater treatment plants can effectively handle liquid medical waste as they
would residential waste, the way hospitals actually do it can get
them
into serious trouble if they’re not careful or smart.

When it comes to treating and disposing or simply collecting
and disposing of fluid medical waste, hospitals and other healthcare facilities
have four primary choices.

"Believe it or not, some hospitals take shortcuts," said
David Watermeier, director of marketing for
Saf-T Pump from Cardinal acute care at DeRoyal Industries
Inc. (Knoxville, TN). He called one of them "cap and can." Basically, the
healthcare worker places the cap on the filled suction canister and drops it
into the red bag as infectious medical waste. Another involves merely pouring
the contents down the hopper sink and into the drain. With the average national
price range of hauling red bag waste at 21 cents to 30 cents per pound, the
first shortcut can be expensive.

"A full three-liter suction canister weighs nearly 7.5
pounds," noted Chris Hosler, vice president of marketing at Dornoch Medical
Systems Inc. (St. Louis). "The typical operating room will generate about two
tons of fluid waste each month. Disposal of a single three-liter canister can
easily exceed $2.25. In California, we are seeing these costs rise as high as $8
per canister."

The second shortcut can be extremely expensive. That’s
because of the healthcare worker’s dangerous exposure to splashing and
aerosolized particulate matter from the infectious fluid. Even if that
healthcare worker sports all of the required personal protective equipment, the
Occupational Safety and Health Administration still will issue costly citations
because such practice violates OSHA’s bloodborne pathogens standard.

Thankfully, the practice is "definitely trending downward,"
according to Watermeier, but "it still happens." Indeed, Hosler estimates that
roughly 25 percent to 30 percent of hospitals continue to pour potentially
infectious fluids (be it blood, other bodily fluids or irrigation fluids) down
the hopper as standard practice, while others use it as a last-minute option of
convenience. Stephanie Lipp, senior market manager of the Medi-Vac line at
Cardinal Health Inc.’s Medical Products and Services division (McGaw Park, IL)
isn’t so generous. In fact, based on their calculations, her group estimates
that about 65% of hospitals do it this way on a frequent basis. "While this
option may be very economical for the hospital it’s potentially hazardous for
the healthcare worker doing it because he or she is exposed to the untreated
waste through splashing or even aerosolization," Lipp said. Companies like
Cardinal, DeRoyal and Dornoch calculate these percentages based on the number of
suction canisters they sell in a given period.

"But we’ve seen these numbers go down as hospitals become
more aware of the issue and regulations," Hosler said, reassuringly. "They know
that it’s bad practice." How can the waste management companies know this? Trade
show tales all share a common theme: When company representatives ask some
hospital attendees how they handle fluid medical waste they blush, lower their
heads and laugh nervously before admitting their sin in an audible tone barely
above a whisper.

Searching for alternatives

Hospitals and healthcare facilities have two other choices,
either of which is more economical than the other, depending on whom you ask.

One
involves pouring a powdered solidifying agent into the fluid-filled canisters
that turn the liquid content into a gelatinous substance after five to 10
minutes. Then those canisters can be disposed of as red bag waste. Some
solidifiers include sanitizing agents, such as chlorine or glutaraldehyde, which
may allow the treated medical waste to be placed in white bags, depending on
state regulations. At least six companies sell solidifiers for medical
applications, including Colby Manufacturing Corp., DeRoyal Industries Inc.,
DiSorb Systems Inc., Metrex Inc., Microtek Medical Inc., Safetec of America Inc.
and ZappaTec LLC. (See chart.)
Dornoch Transposal products

The newest choice revolves around closed disposal systems
that are designed to collect the fluid waste in and dispose of it down the
sewers with minimal – if any – human contact with the waste. Most are stationary
systems mounted to the floor or wall. One model comprises a mobile "rover" that
can be wheeled around to

different rooms but must be berthed in a docking station to empty. At
least five companies sell these systems, including Bemis Manufacturing Corp.,
Cardinal Inc., DeRoyal Industries Inc., Dornoch Medical Systems Inc. and Stryker
Corp. (See chart.).

Because these systems are relatively new (Cardinal’s Saf-T-Pump,
for example, debuted last September), market penetration is rather small –
estimated to be in the low single-digit range. By and large, the majority of
hospitals and other healthcare facilities either pour untreated liquid waste
down the drain, dispose of full or partially filled canisters intact as red-bag
waste or solidify it and dispose of the canisters as either red- or white-bag
waste if their state deems it legal. More than likely, healthcare facilities use
some combination of choices.

With federal and state regulations stymieing the use of
incinerators and imposing new packaging requirements that make it more expensive
to dispose of fluid waste offsite, as well as consolidation in the medical waste
hauling business shrinking the industry to one primary vendor and a few
secondary players, hospitals and other healthcare facilities simply want an
alternative to rising prices. "It’s pushing people to look at how to treat and
dispose of waste onsite without exposing their employees to any hazards," Hosler
said.

Evaluating choices

Manufacturers that offer closed collection and disposal
systems and/or solidifiers offer a litany of tips on how to make the right fluid
waste management decision for your facility. Obviously safety is paramount.
"First and foremost, any new control must protect employees from exposure to
fluid waste," Hosler noted. "The control should be easy to use and have proven
efficacy in handling all types of suction canister waste, including whole blood
and blood clots."

In addition, the control must also satisfy all applicable
regulations – from OSHA, the Department of Transportation (DOT) and the
Environmental
DeRoyal
Suction products
Protection Agency (EPA) – regarding the safe handling and disposal
of infectious waste, he added.

However, most facilities focus on the

economic impact – how much will the control cost the facility? Hosler put it in
perspective this way: "Almost 70 percent of an operating room’s infectious waste
is related to suction canisters. Disposal of this infectious waste is over 10
times as expensive as regular trash."

Essentially, healthcare facilities have to invest in suction
canisters and solidifiers (non-sanitizing or the more costly sanitizing
versions) and then deal with red bagging weighty canisters, according to Lipp.
For example, a full three-liter canister may weigh eight pounds after
solidification. At 30 cents per pound you’re adding $2.40 to the cost of the
canister and solidifier. "Depending on the surgical procedure a facility may use
between four and eight canisters per procedure," Lipp said, "so you’re
looking at a boatload of money collecting, treating and disposing of fluid
waste." Meanwhile, closed systems enable facilities to dispose of empty
canisters in the white-bag waste stream, she added.

DOT requires special packaging – either reusable or
disposable – for waste haulers to properly transport fluid-filled suction
canisters. Healthcare facilities must provide this packaging, which can add 10
percent to 20 percent to the infectious

SafeSorb bottles from DiSorb Systems
waste disposal cost, according to Hosler. And if the packaging is
reusable, hospitals have to clean and disinfect it between uses.

Watermeier noted that hospitals also need to check with their
landfill operators to make sure they will accept solidified fluid medical waste,
even if the hospital satisfies all regulatory requirements.

Hosler cited "dosage dependency" and "treatment efficacy" as
two other reasons to keep in mind if you favor solidifiers. End users may
overdose the canisters and waste product or underdose the canisters, which will
lead to leaking, he said. Hosler also noted that solidifiers claiming "treatment
or sanitization" base their efficacy on blood serum testing and not on whole
blood or blood clots."

Finally, healthcare facilities have to continually order and
store bottles of solidifying powder.

Keeping minds open on closed systems

Closed systems also have their own mitigating factors to
consider. While solidifiers represent an ongoing minimal expense (not including
the suction canister and red-bag waste hauling costs), closed systems require a
large capital expenditure upfront, which can range between $4,000 on the low end
to $50,000 on the high end. But that doesn’t include the ongoing costs for
related consumables, such as disposable lids, manifolds or tubes, and cleaning
and disinfecting agents necessary for operation.

While solidifier users can buy suction canisters from any vendors they choose,
closed system users may not enjoy such flexibility. Typically, they have to buy
the canisters, also called collectors, from the manufacturers of the systems
themselves. Cardinal claims that healthcare facilities can use competitors’
canisters in its system, but then that system doesn’t perform as a closed system
due to fitted components, Lipp noted. "The Cardinal dip tube is fitted to the
top of the canister," she said. "Other brands aren’t fitted so there’s an
aerosolization problem when the unit sucks out fluid. Our components are geared
to our products. Our system can work with other canisters but you will have that
safety factor."

Watermeier offers a number of other variables to consider
when comparing and evaluating closed systems. They include the evacuation rate
(how long it takes for the canisters to empty), ease of installation and ease of
use, how much space it will occupy, where the unit will be installed
(particularly if it has mobile components), whether the system has an
optional treatment parameter and
whether the manufacturers will bundle related products into the deal, such as
disposable or reusable canisters.

Eventually the plastic material in the reusable canisters may
break down after repeated cleaning and disinfection so those canisters must be
replaced, according to Ted McLaughlin, president of DiSorb Systems Inc.
(Philadelphia).

McLaughlin, whose company manufactures a non-sanitizing
solidifier that can be added to an empty canister before a surgical procedure,

In fact, McLaughlin provides a cost savings calculator on his
company’s Web site that allows potential customers to plug in their usage data
and compare the costs between his product and two prominent closed systems, as
well as a sanitizing solidifier. Other companies provide such a service via CD
or via a sales representative running the numbers on his or her laptop computer.

McLaughlin merely finds closed systems labor intensive.
"Someone has to collect, transport and process the waste, maintain a
verification log, clean and disinfect the canisters or collectors and
redistribute them," he said. "Plus, the equipment has to be maintained by the
biomedical engineering department so they have to be trained on how to use it so
they can repair it. Clinicians have to be trained on it. Most of all, clinicians
have to be trained not to throw away the canisters or collectors. With everybody
wearing seven hats in today’s healthcare environment it just doesn’t make
sense."

Still, McLaughlin advocates anything but simply pouring
liquid waste down the hopper sink. "It only takes one contaminated worker to
offset any potential savings you can fathom," he said.

HPN

Editor’s Note: Be sure to visit the company Web sites listed
in the Waste Watchers chart because several of them offer useful help in making
economic decisions as well as useful explanations of regulations with links to
regulatory sites.